Heparin brand is associated with postsurgical outcomes in children undergoing cardiac surgery

Background: We sought to determine whether the use of specific unfractionated heparin brands during cardiopulmonary bypass for pediatric cardiac surgery was associated with differences in postoperative outcomes, especially regarding the incidence of bleeding and thromboembolic complications. Methods: We compared postoperative outcomes for pediatric cardiac surgeries performed with Hepalean (Organon Teknika) to those performed with PPC heparin (Pharmaceutical Partners of Canada). Differences in clinical outcomes were determined in multivariable logistic and linear regression models adjusted for patients and surgery characteristics. Results: In all, 903 operations were reviewed, 289 (32%) using Hepalean and 614 (68%) using PPC heparin. Patient demographics and surgical variables were comparable between groups. In multivariable regression models, adjusted for patients' characteristics, heparin use and choice of antifibrinolytic agents, the use of PPC heparin was associated with greater use of red blood cell transfusions in the first 48 postoperative hours (estimates +1.6 mL/kg, p < 0.001), increased odds of bleeding complications (odds ratio 3.8, p = 0.04), thromboembolic complications (odds ratio 4.7, p = 0.01), early unplanned reoperation (odds ratio 6.9, p = 0.03), longer postoperative intensive care unit stay (estimate +3.2 days, p < 0.001), and longer hospital stay (estimate +3.6 days, p < 0.001). Conclusions: Brand of unfractionated heparin used during cardiopulmonary bypass for pediatric cardiac surgery was associated with bleeding complications and clinical outcomes. Different brands of unfractionated heparin should not be considered equivalent without proper validation in formal trials.